Reproduced by Sabinet Online in terms of Government Printer s Copyright Authority No dated 02 February 1998 NOTICE 1038 OF 2012

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1 STAATSKOERANT, 14 DESEMBER 2012 No GENERAL NOTICE NOTICE 1038 OF 2012 DEPARTMENT OF TRANSPORT ROAD ACCIDENT FUND (TRANSITIONAL PROVISIONS) ACT, (ACT NO. 15 of 2012.) ROAD ACCIDENT FUND (TRANSITIONAL PROVISIONS) REGULATIONS, 2012 The Minister of Transport hereby, in terms of section 2(1) and 2(1)(d) of the Road Accident (Transitional Provisions) Act No.15 of 2012 intends to make the regulations in the Schedule. Interested persons are invited to send their written comments on the draft regulations to the Director General, Department of Transport within 30 days from the date of publication hereof, for the attention of Adv Adam Masombuka at the following address masombua dotgov.za Tel (012) Fax The Department of Transport Private Bbag x 193 PRETORIA

2 4 No GOVERNMENT GAZETTE, 14 DECEMBER 2012 SCHEDULE Definitions 1. In these Regulations unless the context indicates otherwise, an expression or word given to a meaning in the Act has the same meaning- "The Act" means the Road Accident (Transitional Provisions) Act, No.15 of 2012; and "Regulations" means regulations in terms of the Road Accident (Transitional Provisions) Act, No.15 of Election of statutory regime by the third party 2. A third party who elects in terms of section 2(1) of the Act to have the claim dealt with in terms of the old Act shall submit to the, in accordance with the procedure specified in section 24(1) of the old Act, an Election Form ("RAFTP 1") attached as as Annexure A to to these Regulations. 2

3 STAATSKOERANT, 14 DESEMBER 2012 No Declaration of compensation received by the third party 3. A third party who does not elect in terms of section 2(1) of the Act to have the claim dealt with in terms of the old Act shall submit to the, in accordance with the procedure specified in section 24(1) of the new Act, a Disclosure Form ("RAFTP 2") 2") attached as Annexure B to to these Regulations. Short Title and Commencement 4. This Regulation shall be called the Road Accident (Transitional Provisions) Regulations 2012 and shall come into operation on the date of publication thereof. 3

4 6 No GOVERNMENT GAZETTE, 14 DECEMBER 2012 ANNEXURE Road Accident TI 11491S OF THIRD PARTY Surname 1 Residential address I Postal address Cell 2 PARTICULARS OF PERSONS) REPRESENTED BY THIRD PARTY 1. Surname 2. Surname Page 1

5 STAATSKOERANT, 14 DESEMBER 2012 No ELECTION FORM RAF TP 1 2 PARTICULARS OF PERSON(S) REPRESENTED BY THIRD PARTY IBM B - r.7 r I 7. 7, 7_ PARTICULARS OF ACCIDENT 1 1 I "SA H H MM s N1 A ROAD ACCIDENT FUND CLAIM NUMBER (To be completed where a claim has already been lodged with the Road Accident ).; =

6 8 No GOVERNMENT GAZETTE, 14 DECEMBER Road Accident A I, the third party with the details reflected in paragraph 1 above hereby declare under oath / affirm that I irrevocably elect in terms of subsection 2(1) of the Road Accident (Transitional Provisions) Act, 2012 that my daim and the daims(s) of the person(s) identified in paragraph 2 above and in any annexure to this form, arising from the accident identified in paragraph 3 above, remain subject to the old Act. Signature of deponent Date of signature CERTIFICATION: I hereby certify that before administrating the oath / taking the affirmation I asked the deponent the following questions and noted his I her answers in his / her presence as indicated below: 1. Do you know and understand the contents of the above declaration? 2. Do you have any objection to taking the prescribed oath? 3. Do you consider the prescribed oath to be binding on your conscience? I hereby certify that the desponent has acknowledged that he / she knows and understands the contents of this declaration which was sworn to / affirmed before me and the deponent's signature was placed thereon in my presence. Signature of Justice of the Peace / Commissioner of Oaths Surname First Names Designation Area for which appointed Business address Place of signature Date of signature Page 3

7 STAATSKOERANT, 14 DESEMBER 2012 No ANNEXURE B Road Accident PARTICULARS OF THIRD PARTY Surname Residential address I Postal address Home Telephone WorkTelephone Cell AMOUNTS RECOVERED AND RECEIVED BY THIRD PARTY a. Indicate the amount recovered from the driver/owner/employer of the driver of the motor vehicle involved in the accident: RI II II 1111 II R b. Indicate the amount received as an interim payment in terms of section 17(6) of the old Act c. Indicate the amount paid to suppliers in terms of section 17(5) of the old Act R d. Indicate the amount received in terms of the Compensation for Occupational Injuries and Diseases Act, 1993; the Defence Act, 2002 or any other Act of Parliament governing the South African National Defence Force: R T Page 1

8 WO 10 No GOVERNMENT GAZETTE, 14 DECEMBER 2012 Ro cadent A folop ia II I 0 9 I% MAI 1. Surname With reference to the amounts recovered or received contemplated in paragraph 2 (a) - (d) above indicate which such amounts have been recovered or received: 2. Surname I II With reference to the amounts recovered or received contemplated in paragraph 2 (a) - (d) above indicate which such amounts have been recovered or received: R b. 3. Surname With reference to the amounts recovered or received contemplated in paragraph 2 (a) - (d) above indicate which such amounts have been recovered or received: R a. b. page 2

9 STAATSKOERANT, 14 DESEMBER 2012 No * o S 10, 0 a Ro &lent A 0 A 4. Surname With reference to the amounts recovered or received contemplated in paragraph 2 (a) amounts have been recovered or received: (d) above indicate which such b. C. d. If more than four persons are represented kindly furnish the details of the additional person(s) in an annexure. ROAD ACCIDENT FUND CLAIM NUMBER 0 (To be completed where a claim has already been lodged with the Road Accident ) page 3

10 12 No GOVERNMENT GAZETTE, 14 DECEMBER Road Accident A.1 ek I, the third party with the details reflected in paragraph I above hereby declare under oath / affirm that the information furnished in this form and any annexure to this form is to the best of my belief true and correct. Signature of deponent Date of signature CERTIFICATION: I hereby certify that before administrating the oath / taking the affirmation I asked the deponent the following questions and noted his / her answers in his / her presence as indicated below: I. Do you know and understand the contents of the above declaration? 2. Do you have any objection to taking the prescribed oath? 3. Do you consider the prescribed oath to be binding on your conscience? I hereby certify that the desponent has acknowledged that he / she knows and understands the contents of this declaration which was sworn to / affirmed before me and the deponent's signature was placed thereon in my presence. Signature of Justice of the Peace / Commissioner of Oaths Surname First Names Designation Area for which appointed Business address Place of signature Date of signature page 4